Healthcare Provider Details

I. General information

NPI: 1306844246
Provider Name (Legal Business Name): 245 ORANGE AVENUE OPERATING COMPANY II LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 ORANGE AVE
MILFORD CT
06460-2104
US

IV. Provider business mailing address

245 ORANGE AVE
MILFORD CT
06460-2104
US

V. Phone/Fax

Practice location:
  • Phone: 203-876-5123
  • Fax: 203-876-5129
Mailing address:
  • Phone: 203-876-5123
  • Fax: 203-876-5129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2278
License Number StateCT

VIII. Authorized Official

Name: KEVIN BRESLIN
Title or Position: EXECUTIVE VP
Credential:
Phone: 201-242-4004